Empowerment or responsibilisation: Articulation work in English primary care coordination from the perspectives of patients and clinicians

In many well-developed primary care systems patients increasingly receive care from multiple clinicians within networks of providers rather than a single general practice clinician. This makes formal coordination between clinicians and providers necessary and requires informal 'articulation work' from both clinicians and patients to organise coordination of tasks across episodes of care. This is often hidden 'behind the scenes'. We used qualitative data from interviews with patients (n = 55) and healthcare professionals and other practice staff (n = 57) from two linked studies in English general practice. These studies investigated aspects of implications of the organisational shift to primary care networks. Using these datasets, we explored expectations about the articulation work involved in coordinating care. We found differing experiences of primary care coordination and differing expectations about who bears responsibility for the articulation work involved. Patients tend to assume a cyclical care process in which care coordination continues between interactions with the practice, maintaining a care cycle. In contrast, contemporary primary care processes are structured to be 'acute by default', with patients responsible for re-initiating care after each care episode. Increasing responsibilisation of patients adds to their burden of treatment. Without the knowledge or capacities for such work patients may experience failures in care coordination. Better aligning expectations about responsibilities for articulation work requires explicit communication, sensitivity and flexibility in identifying patients who may find this difficult, facilitated by an ongoing patient-clinician relationship.